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Clinical Years / Progress Test > Haematology > Flashcards

Haematology Flashcards

1
Q

Causes of microcytic anaemia

A

iron deficiency - diet, malabsorption or blood loss
thalassaemia

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2
Q

causes of normocytic anaemia

A

chronic disease
acute blood loss
renal failure - EPO deficient
RBC destruction

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3
Q

causes of macrocytic anaemia

A

B12 def
Folate def
pregnancy
alcohol
hypothyroidism
aplastic anaemia
myeloma
liver disease

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4
Q

what can cause haemolytic anaemias

A

note these are rare
- congenital; membrane, enzyme (G6PD) of Hb disorders of RBCs
- acquired; wilson’s disease, autoimmune, drugs

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5
Q

management of beta thal major

A

long term blood transfusions + iron chelation

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6
Q

tests for haemolysis

A

Coomb’s test:
1. indirect antiglobulin test - to cross match blood
2. Direct Antiglobulin Test - detect patients own antibodies to their red cells

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7
Q

mechanism of action and reversal of dabigatran

A

direct thrombin inhibitor
idarucizumab to reverse

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8
Q

universal FFP donor

A

AB RhD negative

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9
Q

what is lymphoma? how does it normally present

A

normal lymphoid structure replaced by malignant cells
bimodal ages; younger then in older age
Smooth, firm lymph nodes, dry cough, tiredness and B symptoms (weight loss, night sweats and fever)

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10
Q

types of lymphoma

A

hodgkins; reed-sternberg cells

non-hodgkins:
- diffuse large B cell (high grade)
- follicular NHL (low grade)
- T cell

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11
Q

lymphoma staging system

A

Ann Arbour
stage 1 - one group of nodes
stage 2 - 2 or more groups but one side of the diaphragm
stage 3 - both sides of the diaphragm
stage 4 - organ involvement (bone, liver, lungs, spleen)

A or B is also assigned based on whether B symptoms present

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12
Q

types of leukaemia

A

Myeloid - acute or chronic
Lymphocytic - acute or chronic

acute - ‘blasts’ on blood film. Pt is anaemic +/- thrombocytopenic. bone marrow failing

chronic - mature cells seen in excess numbers but are malignant and abnormal

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13
Q

what is multiple myeloma?
what symptoms and signs?

A

malignancy arising from the antibody producing plasma B cells
Calcium raised with normal phosphate and ALP
Renal impairment
Anaemia
Bone pain - often back pain. osteolytic lesions in bone

bence jones proteins in urine and plasma

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14
Q

what does prothrombin time measure? what factors affect it?

A

extrinsic pathway
factors, II, V, VII X
warfarin also affects it

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15
Q

what does activated partial thromboplastin time (APTT) measure? what factors/things affect it?

A

intrinsic pathway
factors VIII, IX, XI, XII
also heparin and von willebrand deficiency

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16
Q

what causes both PT and APTT to be prolonged?

A

vitamin K deficiency
disseminated intravascular coagulation

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17
Q

what is the premise of the 50:50 plasma test?

A

mix 50% patients plasma and 50% normal
if problem is a factor deficinecy then clotting times will correct
if an inhibitor is present then it wont correct

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18
Q

Haemophilia A and B
what are they?
management?

A

A = factor VIII deficiency
B = factor IX deficiency

A; give factor VIII 3x daily. amount depends on severity
also can give desmopressin

B; give factor IX 1x daily

both can give tranexamic acid in a bleed

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19
Q

CLL complications

A
  • anaemia
  • hypogammaglobulinaemia leading to recurrent infections
  • warm autoimmune haemolytic anaemia in 10-15% of patients
  • transformation to high-grade lymphoma (Richter’s transformation)
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20
Q

management of essential thrombocytosis

A

hydroxyurea

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21
Q

what is von willebrands disease?
symptoms
types

A

inherited bleeding disorder of reduced vWF which is a carrier for factor VIII and promotes platelet adhesion
epistaxis and menorrhagia are common symptoms

type 1 - partial reduction (80% of patients)
type 2 - abnormal vWF
type 3 - no vWF

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22
Q

investigation results in von willebrands disease
management

A

prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation

management: Tranexamic acid for bleeds, desmopressin, factor VIII concentrate

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23
Q

causes and blood results of Disseminated Intravascular Coagulation

A

causes:
- trauma
- sepsis
- obstetric complications
- malignancy

blood results:
decreased platelets and fibrinogen
increased APTT, PT

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24
Q

long term management of sickle cell disease

A

hydroxyurea
pneumococcal vaccine every 5 years

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25
Q

management of a sickle cell crisis

A

analgesia e.g. opiates
rehydrate
oxygen
consider antibiotics if evidence of infection
blood transfusion
exchange transfusion: e.g. if neurological complications

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26
Q

blood transfusion complications

A

-immunological: acute haemolytic, non-haemolytic febrile, -allergic/anaphylaxis
-infective
-transfusion-related acute lung injury (TRALI)
-transfusion-associated circulatory overload (TACO)
-other: hyperkalaemia, iron overload, clotting

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27
Q

typical presentation of CML

A

60-70 years old
anaemia –> lethargy
drenching night sweats
massive splenomegaly
weight loss
leukocyte alkaline phosphatase

thrombocytosis and lymphocytosis

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28
Q

treatments of:
CML
CLL
NHL

A

CML = imatinib
CLL = Fludarabine, cyclophosphamide and rituximab (FCR). second line is ibrutinib
NHL = Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) is used in the treatment of Non-Hodgkin’s lymphoma (NHL).

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29
Q

ALL presentation

A

typically 2-5 years old
anaemia and splenomegaly
increased lymphocytes, + neutropenia and thrombocytopenia

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30
Q

what is the preferred anticoagulant if renal function is impaired?

A

apixaban

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31
Q

Iron profile in haemochromatosis

A

Raised transferrin and ferritin. Low total iron binding capacity

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32
Q

threshold for transfusion in anaemia

A

gernerally <70g/l
in ACS <80g/L

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33
Q

symptoms and treatment for immune thrombocytopenia

A

more common in females. presents with petechiae, epistaxis and bleeding gums
first line treatment is oral prednisolone

34
Q

test for autoimmune haemotlyic anaemia

A

direct coombs test

35
Q

polycythaemia vera
what is it
risks
treatment
prognosis

A

myeloproliferative disorder caused by clonal proliferation of a marrow stem cell where all cell counts are raised particularly RBCs

increased risk of thrombotic events - stroke and MI

patients should be on low dose aspirin
venesection to reduce Hb
chemotherapy can be beneficial

thrombotic events common
5-15% of patients progress to myelofibrosis
5-15% of patients progress to acute leukaemia

36
Q

Which clotting factors are affected by heparin

A

Prevents activation of factors 2, 9, 10, 11

37
Q

What clotting factors are affected by warfarin

A

2, 7, 9, 10

38
Q

management of anti-phospholipid syndrome in pregnancy

A

low dose aspirin once pregnancy confirmed on urine testing

LMWH once fatal heart on ultrasound then discontinue at 34 weeks

39
Q

general features of autoimmune haemolytic anaemia

A

Normocytic anaemia
Reticulocytosis
Raised LDH and bilirubin

40
Q

management of autoimmune haemolytic anaemia

A

warm; steroids +/- rituximab

cold; responds less well to steroids

41
Q

how does beta thal major present

A

in first year of life with failure to thrive and hepatosplenomegaly

42
Q

what is desferrioxamine

A

iron chelation therapy

43
Q

in what conditions are ‘target cells’ seen on blood film

A

Sickle-cell/thalassaemia
Iron-deficiency anaemia
Hyposplenism
Liver disease

44
Q

in what conditions are ‘tear-drop’ poikilycytes seen on blood film

A

myelofibrosis

45
Q

in what conditions are ‘spherocytes’ seen on blood film

A

Hereditary spherocytosis
Autoimmune hemolytic anaemia

46
Q

in what conditions are ‘basophilic stippling’ seen on blood film

A

Lead poisoning
Thalassaemia
Sideroblastic anaemia
Myelodysplasia

47
Q

in what conditions are Howell-Joly bodies seen on blood film

A

hyposplenism

48
Q

in what conditions are Heinz bodies seen on blood film

A

G6PD deficiency
Alpha-thalassaemia

49
Q

in what conditions are Schistocytes (‘helmet cells’) seen on blood film

A

Intravascular haemolysis
Mechanical heart valve
Disseminated intravascular coagulation

50
Q

in what conditions are pencil poikilocytes seen on blood film

A

iron deficiency anaemia

51
Q

in what conditions are Burr cells seen on blood film

A

Uraemia
Pyruvate kinase deficiency

52
Q

types of blood transfusion reaction

A

Immunological
Infective
Transfusion Related Lung Injury
Transfusion Associated Circulatory Overload

53
Q

Non Haemolytic febrile reaction to blood transfusion

A

Fever and chills

slow or stop the transfusion, paracetamol and monitor

54
Q

minor allergic reaction to blood products

A

pruritus and urticaria

temporarily stop the transfusion, give antihistamines and monitor

55
Q

anaphylaxis reaction to blood products

A

hypotension, dyspnoea, wheezing, angioedema

stop the transfusion, IM adrenaline and A-E support

56
Q

Acute haemolytic reaction to blood products

A

ABO incompatibility - human error

Fever, abdominal pain, hypotension

Stop transfusion , supportive care

57
Q

Transfusion associated circulatory overload

A

Excessive rate of transfusion
More likely in pre existing heart failure

Pulmonary oedmea and hypertension

Slow or stop transfusion. Consider IV loop diuretic

58
Q

Transfusion-related acute lung injury

A

Hypoxia, pulmonary infiltrates on CXR, fever, hypotension

Stop transfusion. Oxygen and supportive care

59
Q

Red blood cell transfusion thresholds and targets

A

Without ACS: threshold 70g/L
Target 70-90

With ACS: threshold 80 g/L
Target 80-100

60
Q

Richter’s transformation presentation.

A

CLL transformation to a high grade non-Hodgkin lymphoma

Presents with rapidly growing lymph node, fever, weight loss, night sweats, nausea, abdo pain

61
Q

CLL investigation findings

A

Leukocytosis
Anaemia
Thrombocytopenia
Smudge/smear cells on blood film
Immunophenotyping is done

62
Q

Next steps if DVT likely on two level wells score

A

Ultrasound the leg - if DVT present start anticoagulation

If USS negative do a D-dimer
If negative DVT unlikely
If positive then re scan in a few days and monitor

If can’t USS within 4 hours then anticoagulate in the meantime

63
Q

Next steps if DVT unlikely on two level wells score (1 point or less)

A

D dimer within 4 hours
- if positive then USS leg within 4 hours (anticoagulate if longer)
- if negative DVT unlikely

64
Q

Choice of anticoagulant in DVT

A

DOACs from start in most patients (rivaroxaban or apixaban first line)

If not suitable LMWH followed by warfarin
E.g. in antiphospholipid syndrome or severe renal impairment

65
Q

acute haemolytic reaction to blood products

A

ABO incompatibility - human error

fever, abdominal pain and hyptension

stop transfusion

66
Q

Factor V Leiden

A

Activated protein C resistance
Most common form of inherited thrombophilia

67
Q

G6PD deficiency
- summary of condition
- features
- diagnostic test

A

Most common red blood cell enzyme defect
Most common in people of Mediterranean and African descent
X linked
Can be precipitated by some drugs, infection, and broad/fava beans

Intravascular haemolysis
Neonatal jaundice
Gallstones common
Heinz bodies on film

Measure enzyme activity of G6PD

68
Q

Hereditary spherocytosis
- summary
- features
- test

A

Autosomal dominant inheritance
More common in people of Northern European descent

Neonatal jaundice
Chronic symptoms of haemoylsis
Gallstones
Splenomegaly
Spherocytes on film

Diagnose with EMA binding test

69
Q

Features of haemophilia

A

X linked

Haemarthroses
Haematoma
Prolonged bleeding after trauma or surgery
Prolonged APTT
Bleeding time, PT, thrombin time all normal

70
Q

Immune thrombocytopenia in adults

A

Immune mediated reduction in the platelet count

More common in older females
May be detected on routine blood tests or present with petechiae, purpura, bleeding

Management is oral prednisone or IVIG if active bleeding

71
Q

Iron studies in iron deficiency anaemia

A

Hb low
Ferritin low (but inflammation can raise it so high ferritin does not rule out IDA)
TIBC/transferrin high
Transferrin saturation low

72
Q

Management IDA

A

Identify cause - may need further investigations e.g. endoscopy (new onset in older people always rule out malignancy)
oral ferrous sulphate until iron restored and then for 3 more months
Iron rich diet

73
Q

Iron studies anaemia of chronic disease

A

Serum iron low but not as low as IDA
TIBC low
Transferrin saturation low
Ferritin high

74
Q

What is a decrease in haptoglobin associated with

A

Intravascular haemolysis

75
Q

Platelet transfusion risk

A

Highest risk of bacterial contamination

76
Q

DVT or PE in pregnancy

A

Warfarin contraindicated

Give SC LMWH

77
Q

Sideroblastic anaemia

A

Microcytic hypochromic anaemia

High iron ferritin and transferrin

Can be congenital or acquired

78
Q

Causes of massive splenomegaly

A

Myelofibrosis
CML
Malaria
Gauchers syndrome

79
Q

What is hydroxycobalamin

A

Vitamin B12 replacement
Given IM

80
Q

Causes of neutropenia

A

Viral
Drugs e.g. cytotoxics, carbimazole
Benign ethnic neutropenia - common in black African or Afro Caribbean
Haematological malignancy
Rheumatological conditions
Severe sepsis

81
Q

Correcting a mixed B12 and folate deficiency

A

Correct B12 first with IM injections then start oral folic acid once normal

Clinical Years / Progress Test (24 decks)

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